THE INFLUENCE OF INHIBITORS OF TUMOUR NECROSIS FACTOR-ALPHA ON THE CLINICAL COURSE OF RHEUMATOID UVEITIS AND DYNAMICS OF IMMUNOLOGICAL CHARACTERISTICS

The present study included 34 children aged from 4 to 16 years presenting with uveitis associated with rheumatoid diseases, such as juvenile idiopathic arthritis (n = 32) and Behcet’s disease (n = 2). The levels of tumour necrosis factor-alpha (TNF-alpha) in blood sera (BS) and lacrimal fluid (LF) were measured in the patients differing in the activity of the inflammatory processes in the eyes within a period from 4 days to 2 years 9 months after the onset of the treatment with TNF-alpha inhibitors (infliximab and adalimumab). A total of 57 BS samples and 27 LF samples taken from the affected eyes were available for the analysis. Active uveitis was diagnosed in 76.9% of the 26 cases in the absence of TNF-alpha in BS and in 35.5% of the 31 cases at the cytokine levels from 2 to 21 pg/ml (i.e. the two-fold difference, p < 0.01). The analogous results were obtained by the measurement of TNF-alpha in LF. Its absence in LF was associated with the inflammatory process in 84.6% of the 13 cases and 14.3% of the 14 cases at the cytokine level from 2 to 10 pg/ml (p < 0.001). Remission of uveitis was most frequently achieved in the patients having low TNF-alpha concentrations in both fluids. It means that remission of uveitis may be achieved and maintained by the reduction of TNF-alpha concentrations in BP and LF to an optimal minimal level; there is no need to completely suppress its secretion. It is concluded that immunological monitoring facilitates the correction of the treatment and the improvement of the outcome of the disease.

uveitis, cytokines, tumour necrosis factor-alpha, juvenile idiopathic arthritis, Behcet’s disease